Key takeaways
- T-cell lymphoma is a relatively uncommon cancer affecting lymphocytes, a type of white blood cell crucial for immune function.
- The symptoms of T-cell lymphoma may vary widely depending on the specific type. Examples may include skin rashes, lesions, swollen lymph nodes, fatigue, and unexplained weight loss.
- Treatment approaches for T-cell lymphoma are tailored to the specific type and stage of cancer, often involving a combination of therapies such as skin treatments, systemic medications, light therapy, and in advanced cases, stem cell transplantation.
Lymphoma is cancer that starts in the lymphocytes, a type of white blood cell of the immune system.
The American College of Hematology reports that lymphoma is the most common kind of blood cancer. It includes both Hodgkin’s lymphoma and non-Hodgkin’s lymphoma, depending on the specific type of lymphocyte involved.
Non-Hodgkin’s lymphoma can be divided into two groups:
- B-cell lymphoma
- T-cell lymphoma
According to the American Cancer Society (ACS), less than
T-cell lymphoma comes in many forms. Treatment and your general outlook depend on the type and how advanced it is at diagnosis.
One type of T-cell lymphoma is cutaneous T-cell lymphoma (CTCL). CTCL mainly affects the skin but can also involve lymph nodes, blood, and internal organs.
Two main types are of CTCL
- Mycosis fungoides causes a variety of lesions that can easily be mistaken for other skin conditions, such as dermatitis, eczema, or psoriasis.
- Sézary syndrome is an advanced form of mycosis fungoides that also affects the blood. It can spread to lymph nodes and internal organs.
Other T-cell lymphomas
- Angioimmunoblastic lymphoma: It tends to be quite aggressive.
- Anaplastic large cell lymphoma (ALCL): It includes three subtypes. It can affect the skin, lymph nodes, and other organs.
- Precursor T-lymphoblastic lymphoma/leukemia: It can start in the thymus and may grow in the area between the lungs.
- Peripheral T-cell lymphoma-not otherwise specified: This is a group of diseases that do not fit other subtypes.
Rare types of T-cell lymphoma
Examples include:
- adult T-cell leukemia/lymphoma
- extranodal natural killer/T-cell lymphoma, nasal type
- enteropathy-associated intestinal T-cell lymphoma (EATL)
- lymphoblastic lymphoma
- lymphoplasmacytic lymphoma (LPL)
Here are several factors that can increase the chance that you develop non-Hodgkin’s lymphoma:
- age (50 years and older)
- sex (more commonly found in males)
- weakened immune system
- infections, such as those the HTLV-1 virus or Epstein-Barr virus (EBV) cause
You may not have any signs of the disease in the early stages. Symptoms vary according to the specific type of T-cell lymphoma.
Some signs and symptoms of mycosis fungoides
- patches of flat, scaly skin
- thick, raised plaques
- tumors that may or may not develop into ulcers
- itching
Signs and symptoms of Sézary syndrome
- red, itchy rash covering most of the body, and perhaps the eyelids
- changes to nails and hair
- enlarged lymph nodes
- edema, or swelling
Other possible signs of T-cell lymphoma
Not all forms of T-cell lymphoma cause symptoms on the skin. Here are some other signs and symptoms to look out for.
- bleeding or bruising easily
- recurrent infections
- fevers or chills with no known cause
- fatigue
- persistent abdominal pain on the left side due to a swollen spleen
- abdominal fullness
- frequent urination
- constipation
It’s important to note that the lists above are not comprehensive. If you have questions or concerns about any signs or symptoms you’re experiencing, talk with a healthcare professional for a proper evaluation.
Your doctor will likely order a biopsy of a piece of abnormal tissue, such as a swollen lymph node, to make a diagnosis.
A lab technician will test the tissue sample to determine what type of lymphoma you have.
Your doctor can also use a type of blood test that measures your blood count. The results can help them diagnose the specific type of lymphoma you have — particularly with mycosis fungoides and Sézary syndrome.
After determining the type of lymphoma you have, your doctor will order additional tests to determine what stage it’s in. CT scans and PET scans are typically used. When children receive a lymphoma diagnosis, doctors generally order an MRI scan for staging.
For T-cell lymphoma, it’s rare for someone to receive an advanced or later stage diagnosis. But in those rare instances, treatment options are available.
Your treatment plan will depend on the type of T-cell lymphoma you have and how advanced it is. It’s not unusual to need more than one type of therapy.
Mycosis fungoides and Sézary syndrome may involve direct treatment on the skin as well as systemic treatment.
Skin treatments
Certain ointments, creams, and gels can be applied directly to your skin to manage symptoms and even destroy cancer cells. Examples of topical treatments include:
- Retinoids (vitamin A-derived drugs): They’re used to stop the growth of cancer cells. Potential side effects are itching, irritation, and sensitivity to sunlight. Retinoids should not be used during pregnancy.
- Corticosteroids: These drugs can help reduce inflammation. Long-term use of topical corticosteroids can lead to thinning of the skin.
- Topical chemotherapy: It’s used to kill cancer cells and is typically prescribed in early stage diagnoses. Side effects of topical chemotherapy may include redness and swelling. Topical chemotherapy can also increase the risk of other types of cancer. However, it tends to have fewer side effects than oral or intravenous chemotherapies.
Systemic treatments
Medications for T-cell lymphomas include pills, injections, and those given intravenously. Targeted therapies and chemotherapy drugs are often combined for maximum effect. Systemic treatments may include:
- a combination of multiple chemotherapy medications
- newer chemo drugs
- immunotherapy drugs, such as monoclonal antibodies like brentuximab vedotin (Adcetris), and other medications like mogamulizumab (Poteligeo) and alemtuzumab (Campath)
In advanced cases, you may need maintenance chemotherapy for up to 2 years.
Potential side effects of chemotherapy
- hair loss
- nausea and vomiting
- constipation or diarrhea
- anemia, a shortage of red blood cells, leading to fatigue, weakness, and shortness of breath
- neutropenia, a shortage of white blood cells, which can leave you vulnerable to infections
- thrombocytopenia, a shortage of blood platelets, which makes it harder for your blood to clot
Light therapy
UVA and UVB light can kill cancer cells on the skin. Light therapy is usually given several times a week using special lamps. UVA light treatment is combined with drugs called psoralens. UVA light activates the psoralens to kill cancer cells.
Side effects include nausea, and skin and eye sensitivity. UV light can increase the chance of developing other cancers later in life.
Radiation
Radiation therapy uses radioactive particles to destroy cancer cells. Healthcare professionals can direct beams to the affected skin so that internal organs aren’t affected. Radiation may cause temporary skin irritation and fatigue.
Extracorporeal photopheresis
Medical professionals use this procedure to treat mycosis fungoides or Sézary syndrome. In a 2-day procedure, your care team will remove your blood and treat it with UV light and drugs that activate when exposed to the light, killing cancer cells. After the blood treatment process, it’s returned to your body.
Side effects are minimal. However, they may include:
- temporary low grade fever
- nausea
- dizziness
- skin redness
Stem cell transplant
A stem cell transplant is when your bone marrow is replaced with marrow from a healthy donor. Prior to the procedure, you’ll need chemotherapy to suppress the cancerous bone marrow.
Complications can include:
- graft failure
- organ damage
- new cancers
If you have CTCL, skin problems may be the only symptom you experience. However, any type of cancer can eventually progress to affect lymph nodes and other internal organs.
Overall, the 5-year relative survival rate for non-Hodgkin’s lymphoma is
As with any type of cancer, it’s important to follow up with your doctor as recommended. Your recovery and outlook depend on the specific type of T-cell lymphoma and stage at diagnosis. Other considerations are the type of treatment, age, and any other health conditions you might have.
Your doctor can best assess your situation and provide insight about what to expect after receiving a diagnosis.